Impact of renal denervation for the treatment of resistant hypertension. Literature review
Keywords:
denervación renal, hipertensión arterial resistente, presión arterial, ciencias médicasAbstract
Resistant hypertension (RH) presents a significant therapeutic challenge due to its association with increased cardiovascular risk and high healthcare costs. Renal sympathetic denervation has re-emerged as a minimally invasive alternative to modulate sympathetic nervous system activity and sustainably reduce blood pressure in patients with RH. The aim of this study is to describe the impact of renal denervation on the treatment of RH, analyzing its efficacy in reducing blood pressure, its safety profile, and its effects on quality of life, compared to standard pharmacological management. A systematic review was conducted in PubMed, ScienceDirect, and Dialnet, including human studies in English and Spanish published between 2015 and 2025. Clinical trials, systematic reviews, and meta-analyses that evaluated efficacy, safety, short- and long-term outcomes, and changes in pharmacological treatment in adult patients with RH were selected; animal studies, case reports, letters to the editor, and studies with poor methodological quality were excluded. Forty-four studies were analyzed. Most trials and meta-analyses showed significant reductions in ambulatory and office blood pressure, generally between 3–8 mmHg in 24-hour measurements and greater reductions in office pressure, with the effect maintained for up to 9–10 years in long-term follow-up. Adverse events were infrequent and predominantly mild (pain at the puncture site, hematomas), although isolated vascular and cerebrovascular complications were reported. Several studies documented a reduction in the number of antihypertensive medications and an indirect improvement in quality of life by decreasing polypharmacy and side effects. It is concluded that renal denervation is an effective and generally safe option for the management of resistant hypertension, with a sustained antihypertensive effect and the potential to optimize drug regimens and quality of life. Its clinical incorporation requires careful candidate selection, specialized infrastructure, and health policy decisions that consider its long-term cost-benefit ratio.
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